Palliative Stenting for Late Malignant Gastric Outlet Obstruction

Abstract

Malignant gastric outlet obstruction (MGO) is a late complication of pancreatobiliary and gastric cancers.Although surgical gastrojejunostomy provides good palliation, many of these patients may be nonoperative candidates or underwent previous extensive resection such as a Whipple procedure. Recently, endoscopically placed self-expanding metallic stents (SEMS) have been used to palliate MGO. The aim of this study was to evaluate the efficacy of SEMS for palliation of late MGO. Medical records of patients with endoscopic placement of SEMS for palliation of MGO were reviewed. Results showed that 30 patients with MGO had SEMS placed for late gastroduodenal (n=20) or jejunal (n=10) obstruction. Twenty-one patients (70%) had previous surgery. Return to oral feeding was observed in 90% of patients who presented with recurrent obstruction after prior bypass surgery and in 88% of nonoperative patients in whom SEMS were placed as the primary therapy for obstruction. No major complications were observed, and median survival after SEMS was 4.1 months (0.1 to 10.5 months). SEMS also did not interfere with biliary drainage. In conclusion, endoscopically placed SEMS are safe and provide good palliation for late malignant gastroduodenal and jejunal strictures and are an excellent complement to recurrent obstruction after surgical gastrojejunostomy.

Gastric Outlet Obstruction Palliation: A Novel Stent-Based Solution

“…Palliative upper gastrointestinal stenting has a reported initial success rate of 67–100% [2, 11, 12]; however, conventional approaches using commercially available stents still carry significant complication rates, most notably stent migration [7] and tumor ingrowth [11]. Despite these potential limitations, the current consensus among many thoracic oncologic surgeons is that stents are a superior approach for achieving relief of dysphagia when compared to other palliative modalities [13].…”

The Obstructed Pancreatico-biliary Drainage Limb: Presentation, Management, and Outcomes

“…7 For instance, Kiely et al report a series of 30 patients with postoperative malignant gastric outlet obstruction treated with endoscopically placed metal enteric wall stents. 8 Furthermore, isolated postoperative obstructive strictures in the pancreatic or biliary systems have also been successfully treated using both endoscopic and percutaneous transhepatic approaches. 9 However, these have most commonly been applied to narrow-caliber ductal anastomotic strictures.…”